RECENT data shows a significant increase in germline genetic testing (GGT) for prostate cancer, with a notable rise in urologist involvement, especially for younger patients and those without a family history.
This shift follows the 2018 expansion of the National Comprehensive Cancer Network (NCCN) guidelines, which broadened testing criteria to include patients with high-risk factors such as family history, Ashkenazi Jewish ancestry, and advanced cancer stages.
The study analysed data from 17,256 prostate cancer patients, with 14,400 linked to a provider’s specialty. Between 2015–2020, the quarterly number of prostate cancer patients undergoing GGT rose from 21 in Q2 of 2015 to 1,509 in Q3 of 2020. This period saw an overall increase in the proportion of tests ordered by urologists, which grew from 0% in 2015 to 8.3% by late 2020 (P<0.001). The trend was accompanied by a slight dip in 2020 due to the COVID-19 pandemic.
Among the specialties, medical oncology accounted for the most orders (8,099 tests), followed by medical genetics (2,824 tests), urology (915 tests), primary care (581 tests), and radiation oncology (438 tests). Urologists ordered more tests for patients under 70 years (66%) compared to other specialties (51–55%, P<0.004), and for those with no family history of cancer (25% versus 12–20%, P=0.012).
Urologists also tended to order larger gene panels, with 51% of their orders containing more than 80 genes, versus 29.4–31.5% among other specialties (P<0.001). These findings suggest that as GGT gains prominence in prostate cancer care, educational support could help urologists align testing criteria with guideline-driven practices.
Aditya Bagrodia, senior author and associate professor of urology at the University of California, San Diego, USA, emphasised the importance of urologist involvement, noting, “It is critical that urologists understand when to order germline testing, are comfortable with actually ordering these tests, and integrate medical geneticists when appropriate.”
The authors suggest future research to evaluate the correlation between testing trends and patient outcomes, aiming to further optimise testing practices.
Reference
Roberts JL et al. Germline genetic testing for prostate cancer: ordering trends in the era of expanded hereditary cancer screening recommendations. Urol Oncol. 2024; DOI:10.1016/j.urolonc.2024.10.010.
